Mastitis is inflammation of the breast, most often in breastfeeding women in the first weeks after birth, and it can progress to a bacterial infection. Staphylococcus aureus is the usual germ, and continuing to breastfeed is part of treatment.
Key symptoms
- Painful, warm, red, swollen area of one breast
- Fever, chills and body aches
- Pain during breastfeeding
- Hard, tender lump in the breast
What you find on exam
- Wedge-shaped area of redness and tenderness
- Temperature and pulse
- Fluctuant mass suggesting an abscess
- Nipple cracks and the baby's latch during a feed
Tests
- Mostly a clinical diagnosis
- Breast milk culture if severe, recurrent or not improving
- Ultrasound if an abscess is suspected
- Blood count and blood cultures if septic
Treatment basics
- Keep breastfeeding, without excessive pumping or deep massage
- Ice, NSAIDs such as ibuprofen, and acetaminophen
- Dicloxacillin or cephalexin if bacterial infection is likely
- Clindamycin or trimethoprim-sulfamethoxazole if MRSA is suspected
- Abscess: ultrasound-guided drainage
Red flags
- No improvement after 48 hours of antibiotics
- Fluctuant mass (abscess)
- Low blood pressure, confusion or spreading redness (sepsis)
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.